Zouzoulas Dimitrios, Karalis Tilemachos, Sofianou Iliana, Anthoulakis Christos, Tzika Katerina, Zafrakas Menelaos, Timotheadou Eleni, Grimbizis Grigoris, Tsolakidis Dimitrios
1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, 56403 Thessaloniki, Greece.
Department of Oncology, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, 56403 Thessaloniki, Greece.
Cancers (Basel). 2025 Jun 21;17(13):2076. doi: 10.3390/cancers17132076.
BACKGROUND/OBJECTIVES: Ovarian and endometrial cancers present significant health burdens due to their substantial morbidity and mortality. Surgery delay is hypothesized to negatively impact patient outcomes, yet evidence remains inconsistent. This systematic review aims to comprehensively evaluate current evidence regarding the effects of treatment delay on survival and quality of life in these patients.
A systematic literature search was conducted in MEDLINE (PubMed), Cochrane Library, Scopus, and ClinicalTrials.gov databases, complemented by a manual screening of reference lists, with studies included up to March 2025. Two independent reviewers screened and assessed the methodological quality using the ROBINS-E tool and extracted the data from the studies. Due to substantial methodological and clinical heterogeneity, results were synthesized qualitatively through narrative synthesis.
Twenty-one studies met the inclusion criteria, comprising predominantly retrospective cohort analyses. Treatment delays consistently correlated with decreased survival and advanced disease stages. Among studies, optimal intervals from diagnosis to treatment were varied from 2 to 8 weeks. Patient-reported outcomes indicated heightened anxiety, increased distress, and poor satisfaction with prolonged delays. Healthcare system factors such as resource allocation, geographic disparities, and socioeconomic inequalities significantly contributed to delays. Quantitative survival metrics supported a clear negative association between treatment delays and survival, although paradoxical outcomes in select subgroups highlighted underlying complexities.
This systematic review underscores the critical importance of minimizing delays in the treatment of ovarian and endometrial cancers to improve patient survival and psychological outcomes. Identified healthcare system barriers demand targeted policy interventions to ensure timely and equitable access to tertiary healthcare infrastructures. Future research should prioritize standardizing delay definitions to strengthen and homogenize evidence.
背景/目的：卵巢癌和子宫内膜癌因其高发病率和死亡率而带来重大的健康负担。据推测，手术延迟会对患者的治疗结果产生负面影响，但相关证据仍不一致。本系统评价旨在全面评估当前关于治疗延迟对这些患者生存和生活质量影响的证据。
在MEDLINE（PubMed）、Cochrane图书馆、Scopus和ClinicalTrials.gov数据库中进行了系统的文献检索，并辅以对参考文献列表的人工筛选，纳入截至2025年3月的研究。两名独立 reviewers 使用ROBINS-E工具筛选并评估方法学质量，并从研究中提取数据。由于存在大量的方法学和临床异质性，通过叙述性综合对结果进行定性综合。
21项研究符合纳入标准，主要包括回顾性队列分析。治疗延迟始终与生存率降低和疾病晚期相关。在各项研究中，从诊断到治疗的最佳间隔时间从2周至8周不等。患者报告的结果表明，焦虑加剧、痛苦增加，对长时间延迟的满意度较低。资源分配、地理差异和社会经济不平等之类的医疗系统因素是导致延迟的重要原因。定量生存指标支持治疗延迟与生存之间存在明显的负相关，尽管某些亚组中的矛盾结果突出了潜在的复杂性。
本系统评价强调了尽量减少卵巢癌和子宫内膜癌治疗延迟对于改善患者生存和心理结果的至关重要性。已确定的医疗系统障碍需要有针对性的政策干预措施，以确保及时、公平地获得三级医疗基础设施。未来的研究应优先规范延迟定义，以加强和统一证据。
